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Otolaryngol Head Neck Surg. 2018 Mar;158(3):465-468. doi: 10.1177/0194599817742841. Epub 2017 Nov 21.

Development of an Attachable Endoscopic Nerve Stimulator for Intraoperative Neuromonitoring during Endoscopic or Robotic Thyroidectomy.

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1 Department of Otolaryngology-Head and Neck Surgery and Research Institute for Convergence of Biomedical Science and Technology, College of Medicine, Pusan National University, Yangsan, Korea.
2 Department of Otolaryngology-Head and Neck Surgery, College of Medicine and Medical Research Institute, Pusan National University, Pusan, Korea.


We developed a simple attachable endoscopic nerve stimulator that can be connected to monopolar cauterization surgical instruments. This study on porcine models aimed to investigate the feasibility and efficacy of an attachable endoscopic nerve stimulator for intraoperative neuromonitoring (IONM) before application in humans. We evaluated the electromyography (EMG) amplitudes of 8 recurrent laryngeal nerves in 4 pigs with a conventional nerve probe and the attachable endoscopic nerve stimulator. The attachable endoscopic nerve stimulator was feasible and safe in all cases. There was no significant difference in the EMG amplitude of the recurrent laryngeal nerve among instruments ( P = .429). The application of stimulating dissection with an attachable endoscopic nerve stimulator during endoscopic or robotic thyroidectomy with IONM is simple, convenient, and effective. It provides surgeons with real-time feedback of the EMG response during intermittent IONM. We believe that this novel device could be an essential guide and functional navigator for most surgeons, especially for less experienced ones.


attachable nerve stimulator; endoscopy; neuromonitoring; recurrent laryngeal nerve; robot; thyroidectomy


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